21 NCAC 32B .1602          SPECIAL PURPOSE LICENSE

(a)  The Special Purpose License is for physicians who wish to come to North Carolina for a limited time, scope and purpose, such as to demonstrate or learn a new technique, procedure or piece of equipment, or to educate physicians or medical students.

(b)  In order to obtain a Special Purpose License, an applicant shall:

(1)           submit a completed application, attesting under oath that the information on the application is true and complete, and authorizing the release to the Board of all information pertaining to the application;

(2)           submit a recent photograph, at least two inches by two inches, affixed to the oath, and attested by a notary public;

(3)           submit documentation of a legal name change, if applicable;

(4)           supply a certified copy of applicant's birth certificate if the applicant was born in the United States or a certified copy of a valid and unexpired US passport.  If the applicant does not possess proof of U.S. citizenship, the applicant must provide information about applicant's immigration and work status which the Board will use to verify applicant's ability to work lawfully in the United States;

(5)           comply with all requirements of G.S. 90-12.2A;

(6)           submit the Board's form, completed by the mentor, showing that the applicant has received an invitation from a medical school, medical practice, hospital, clinic or physician licensed in the state of North Carolina, outlining the need for the applicant to receive a special purpose license and describing the circumstances and timeline under which the applicant will practice medicine in North Carolina;

(7)           submit an AMA Physician Profile and, if applicant is an osteopathic physician, also submit AOA Physician Profile;

(8)           submit an FSMB Board Action Data Bank report;

(9)           submit two completed fingerprint record cards supplied by the Board;

(10)         submit a signed consent form allowing a search of local, state, and national files for any criminal record;

(11)         pay to the Board a non-refundable fee pursuant to G.S. 90-13.1(a), plus the cost of a criminal background check;

(12)         upon request, supply any additional information the Board deems necessary to evaluate the applicant's competence and character.

(c)  All reports must be submitted directly to the Board from the primary source, when possible.

(d)  An applicant may be required to appear in person for an interview with the Board or its agent to evaluate the applicant's competence and character.

(e)  An application must be completed within one year of submission.  If not, the applicant shall be charged another application fee, plus the cost of another criminal background check.

History Note:        Authority G.S. 90-8.1; 90-9.1; 90-12.2A; 90-13.1;

Eff. August 1, 2010;

Amended Eff. November 1, 2013;

Pursuant to G.S. 150B-21.3A rule is necessary without substantive public interest Eff. March 1, 2016.